PLEASE DO NOT COMPLETE THIS FORM�
MAKE A COPY OF THE FORM IN YOUR GOOGLE DRIVE�
COMPLETE NEW COPY AND SEND TO LJ�THANK YOU:)
PYRAMID PLUS APPROACH
Training Registration Form
May 7, 2024 - September 10. 2024
LJ Werner , Zoom
Cost: $425
DEADLINE May 1, 2024
Participants in this training are encouraged to come with others from their program/community including coaches, teachers, and administrators. Registration form must be filled out completely.
Email to kidzwithease@gmail.com
Please download this form, complete it, and email to x
REGISTRANT INFORMATION
Please fill out completely!
First Name: ______ Last Name: _______
Job Title/Role (please check all that apply)
❏Administrator Child Care Provider ❏ Consultant/Coach ❏ Early Interventionist ❏ECSE ❏Faculty
❏Family Member ❏Foster Parent ❏Health Provider ❏Infant/Early Childhood Mental Health Consultant
❏Licensing Specialist ❏ Service Coordinator ❏ Service Provider (SLP,OT,PT) ❏ Teacher
❏Trainer/TA ❏Quality Rater ❏Other___
Affiliation (please check all that apply):
Child Care Center ❏Family Child Care ❏School District ❏Early Childhood Council
❏Resource & Referral ❏ Early/Head Start ❏State Agency ❏Mental Health ❏Higher Education
❏Child Welfare System ❏Public Health/Health Care ❏Other: Early Intervention Provider
PYRAMID PLUS APPROACH
Training Registration Form
What age group(s) is/are the focus of your work?
Infant/Toddler (ages 0-3) _ Preschool (ages 3-5) ❏ School Age (6-13) ❏ Adults Learners (21+)
Agency Name:
Agency Address :
City: State: Zip:
County:
Agency Phone: Personal:
Email:
Preferred Pronouns/Special Requirements &/or Requests: ____her/she/hers_______
Payment Information
Payment Plans available with trainer agreement and $150 Deposit.
Please email to arrange. kidzwith@gmail.com
Checks to “with ease” 12590 Ute Hwy Longmont, CO 80504. Include this form
____ Invoice me via PayPal ($10 additional fee)
Bill to this email
______ I am interested in coaching
Pyramid Plus Approach Training (delivered by a Certified Trainer) meets the requirements for Child Guidance Strategies. In order to receive a certificate of attendance you must attend and complete ALL 18 sessions.
PLEASE DO NOT COMPLETE THIS FORM�
MAKE A COPY OF THE FORM IN YOUR GOOGLE DRIVE�
COMPLETE NEW COPY AND SEND TO LJ Werner, Kidzwithease@gmail.com�THANK YOU:)